Pine Haven Job Application

It is the policy of Pine Haven Christian Home, Inc. (Pine Haven Christian Communities) to provide equal opportunity with regard to all terms and conditions of employment. The Company complies with federal and state laws prohibiting discrimination on the basis of age, race, religion, color, sex, national origin, or ancestry, physical or developmental disability, arrest or conviction record, sexual orientation, marital status, military participation or any other protected characteristic.

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Personal Information

Name*

FirstMiddleLast

Phone*

Address*

Street AddressAddress Line 2CityStateZIP Code

Email*

Are you Legally able to work in the U.S.*

Yes

No

Proof of identity and eligibility will be required upon employment.

Are you at least 18 years of age?*

Yes

No

If no, you may be required to provide authorization to work

Do you have any friends or families employed at Pine Haven Christian Communities?*

Yes

No

If yes, give names and relationship*

How did you learn of this position?*

Pine Haven Employee

Website

Newspaper

Job Fair

Refered by Family/Friend

Other

Select all that apply

Name of Employee*

Which Website?*

Which Newspaper?*

Job Fair's Date and Location?*

What is the Referring Family or Friends Name?*

Where did you hear about this position?*

Employment Desired

Position(s) Applied for*

Shift Preferred*

1st

2nd

3rd

Any

Were you previously employed by Pine Haven Christian Communities?*

Yes

No

Name used at time of employment if different from current name.*

If yes, When?*

Would you work:*

Full Time

Part Time

Education

Name of High School*

High School Address

Street AddressAddress Line 2CityStateZIP Code

Last grade completed*

9

10

11

12

Did you graduate?*

Yes

No

Jr. College, College or University

Did you attended a Jr. College, College or University?*

Yes

No

Name of Jr. College, College or University*

Jr. College, College or University Address*

Street AddressAddress Line 2CityStateZIP Code

Major Subjects*

Years Completed*

Degrees*

Did you graduate?*

Yes

No

Did you attend an additional Jr. College, College or University?*

Yes

No

Name of Jr. College, College or University*

Jr. College, College or University Address*

Street AddressAddress Line 2CityStateZIP Code

Major Subjects*

Years Completed*

Degrees*

Did you graduate?*

Yes

No

Vocational School or Other Training?

Did you attended an additional Vocational School or Receive Other Training Including Certificate Programs (i.e.c na)?*

Previous Employment

List most recent employer first. Include employment history for the past 15 years or since high school, whichever is shorter.

1) Employed - Month & Year*

FromTo

1) Employer's Name & Address*

Employer's NameEmployer's Address

1) Employer's Phone*

1) Name of Last Supervisor*

FirstLast

1) Your Title*

1) Job Duties or Tasks*

1) Last salary or wage*

1) Reason for leaving*

Do you have additional employment to add?*

Yes

No

2) Employed - Month & Year*

FromTo

2) Employer's Name & Address*

Employer's NameEmployer's Address

2) Employer's Phone*

2) Name of Last Supervisor*

FirstLast

2) Your Title*

2) Job Duties or Tasks*

2) Last salary or wage*

2) Reason for leaving*

2) Do you have additional employment to add?*

Yes

No

3) Employed - Month & Year*

FromTo

3) Employer's Name & Address*

Employer's NameEmployer's Address

3) Employer's Phone*

3) Name of Last Supervisor*

FirstLast

3) Your Title*

3) Job Duties or Tasks*

3) Last salary or wage*

3) Reason for leaving

3) Do you have additional employment to add?*

Yes

No

4) Employed - Month & Year*

FromTo

4) Employer's Name & Address*

Employer's NameEmployer's Address

4) Employer's Phone*

4) Name of Last Supervisor*

FirstLast

4) Your Title*

4) Job Duties or Tasks*

4) Last salary or wage*

4) Reason for leaving

4) Do you have additional employment to add?*

Yes

No

5) Employed - Month & Year*

FromTo

5) Employer's Phone*

5) Employer's Name & Address*

Employer's NameEmployer's Address

5) Name of Last Supervisor*

FirstLast

5) Your Title*

5) Job Duties or Tasks*

5) Last salary or wage*

5) Reason for leaving*

Account for any gaps of employment greater than 3 months since leaving high school or in the past 15 years, whichever is
shorter. (No reason is e provided at this time).

Gaps in Employment

From: Month / YearTo: Month / Year

Gaps in Employment

From: Month / YearTo: Month / Year

Gaps in Employment

From: Month / YearTo: Month / Year

Pine Haven’s Mission

Pine Haven Christian Communities will provide the aging population we serve an environment that is a Christ-centered, safe haven offering quality, compassionate care.

Based upon Pine Haven's Mission Statement (above), briefly describe what it means to you to have the opportunity to work with an organization which has this mission.*

APPLICANT’S CERTIFICATION AND AGREEMENT

Please read carefully before signing.

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize Pine Haven Christian Communities to verify their accuracy and to obtain reference information on my work performance. I hereby release Pine Haven Christian Communities from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information.

I understand that, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for rescinding an employment offer or terminating employment for cause. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules, and regulations of employment of Pine Haven Christian Communities. However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract.

I understand that any employment offered is for an indefinite duration and at will and that either I or Pine Haven Christian Communities may terminate my employment at any time with or without notice or cause.